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Iopanoic Acid in the Management of Neonatal Graves' Disease

Journal of Perinatology volume 24, pages 105–108 (2004)Cite this article

Abstract

OBJECTIVE: Traditionally, neonatal thyrotoxicosis has been managed with antithyroid drugs and/or iodine as well as sedatives, propranol and digitalis when necessary. The purpose of this study was to evaluate the management of neonatal thyrotoxicosis using the radio-contrast agent iopanoic acid.

METHODS: We managed five cases of neonatal thyrotoxicosis. All infants were treated initially with propranolol (1.7 mg/kg/day) and iopanoic acid 250 to 500 mg every third or fourth day.

RESULTS: In all cases, clinical signs improved and T3 and T4 levels decreased dramatically within 24 to 72 hours. No toxic side effects were noted.

CONCLUSION: Neonatal thyrotoxicosis can be managed successfully using iopanoic acid. Iopanoic acid is essentially free of side effects and need only be administered every 3 to 4 days. When administered until (transplacental) maternal TSI has been metabolized by the neonate, iopanoic acid maintains euthyroid status with no risk of hypothyroidism. With conventional therapy, propylthiouracil (PTU) must be administered three times a day. PTU also carries a significant risk of toxic side effects and a week or more of therapy is required to correct the hyperthyroid state and may induce hypothyroidism.

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References

  1. Fisher DA . The thyroid. In: Kaplan SA, editor. Clinical Pediatric Endocrinology. Philadelphia; PA:WB Saunders; 1990. p. 114–115.

    Google Scholar 

  2. Transue D, Chan J, Kaplan M . Management of neonatal Graves' disease with iopanoic acid. J Pediatr 1992;121:472–474.

    Article  CAS  Google Scholar 

  3. Zakarija M, McKenzie JM . Pregnancy–associated changes in the thyroid–stimulating antibody of Graves' disease and the relationship to neonatal hyperthyroidism. J Clin Endocrinol Metab 1983;57:1036–1040.

    Article  CAS  Google Scholar 

  4. Karpman BA, Rapoport B, Filetti S, Fisher DA . Treatment of neonatal hyperthyroidism due to Graves' disease with sodium ipodate. J Clin Endocrinol Metab 1987;64:119–123.

    Article  CAS  Google Scholar 

  5. Petersen S, Serup J . Neonatal thyrotoxicosis. Acta Paediatr Scand 1977;66:639–642.

    Article  CAS  Google Scholar 

  6. Cove DH, Johnston P . Fetal hyperthyroidism: experience of treatment in four siblings. Lancet 1985;1:430–432.

    Article  CAS  Google Scholar 

  7. Erenberg A, Phelps D, Lam R, Fisher DA . Total and free thyroid hormone concentrations in the neonatal peroid. Pediatrics 1974;53:211–216.

    CAS  PubMed  Google Scholar 

  8. Abuid JL, Klein AH, Foley Jr TP, Larson PR . Total and free triiodothyronine and thyroxine in early infancy. J Clin Endocrinol Metab 1974;39:263–268.

    Article  CAS  Google Scholar 

  9. Fisher DA, Klein AH . Thyroid development and disorders of thyroid function in the newborn. N Engl J Med 1981;304:702–2.

    Article  CAS  Google Scholar 

  10. Wu S, Chopra IJ, Solomon DH, Bennett LR . Changes in circulating iodothyronines in euthyroid and hyperthyroid subjects given ipodate (Oragrafin), an agent for oral cholecystography. J Clin Endocrinol Metab 1978;46:691–697.

    Article  CAS  Google Scholar 

  11. Chopra IJ, Van Herle AJ, Koreman SG, Viosca S, Younai S . Use of sodium ipodate in management of hyperthyroidism in subacute thyroiditis. J Clin Endocrinol Metab 1995;80:2178–2180.

    CAS  PubMed  Google Scholar 

  12. DeGroot LJ, Rue PA . Roentgenographic contrast agents inhibit triiodothyronine binding to nuclear receptors in vitro. J Clin Endocrinol Metab 1979;49:538–542.

    Article  CAS  Google Scholar 

  13. Kohrle J, Hesch RD, Loenard JL . Intracellular pathways of iodothyronine metabolism. In: Braverman LE, Utiger RD, editors. Werner and Ingbar's the Thyroid: a Fundamental and Clinical Text. 6th ed. Philadelphia, PA: JB Lippincott; 1991. p. 144–189.

    Google Scholar 

  14. Wu S, Chopra IJ, Solomon DH, Johnson DE . The effect of repeated administration of ipodate (Oragrafin) in hyperthyroidism. J Clin Endocrinol Metab 1978;47:1358–1362.

    Article  CAS  Google Scholar 

  15. Bürgi H, Wimpfheimer C, Burger A, Zaunbauer W, Rösler H, Lemarchand–Béraud T . Changes of circulating thyroxine, triiodothyronine and reverse triiodothyronine after radiographic contrast agents. J Clin Endocrinol Metab 1976;43:1203–1210.

    Article  Google Scholar 

  16. Wu S, Shyh T, Chopra IJ, Solomon DH, Huang H, Chu P . Comparison of sodium ipodate (oragrafin) and propylthiouracil in early treatment of hyperthyroidism. J Clin Endocrinol Metab 1982;54:630–634.

    Article  CAS  Google Scholar 

  17. Sharp B, Reed AW, Tamagna El, Geffner DL, Hershman JM . Treatment of hyperthyroidism with sodium ipodate (oragrafin) in addition to propylthiouracil and propranolol. J Clin Endocrinol Metab 1981;53:622–625.

    Article  CAS  Google Scholar 

  18. Shen D, Wu S, Chopra IJ, et al. Long term treatment of Graves' hyperthyroidism with sodium ipodate. J Clin Endocrinol Metab 1985;61:723–727.

    Article  CAS  Google Scholar 

  19. Wang Y, Tsou C, Lin W, Hershman JM . Long term treatment of Graves' disease with iopanoic acid (telepaque). J Clin Endocrinol Metab 1987;65:679–682.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, William Beaumont Hospital, Royal Oak, MI, USA

    Sonja M Earles MD, Peter M Gerrits MD & David J Transue MD

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  1. Sonja M Earles MD
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  2. Peter M Gerrits MD
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  3. David J Transue MD
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Earles, S., Gerrits, P. & Transue, D. Iopanoic Acid in the Management of Neonatal Graves' Disease. J Perinatol 24, 105–108 (2004). https://doi.org/10.1038/sj.jp.7211046

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